Provider Demographics
NPI:1508810227
Name:OWENS, CRYSTAL D (MD)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:D
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:IRWINTON
Mailing Address - State:GA
Mailing Address - Zip Code:31042-2611
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:144 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:IRWINTON
Practice Address - State:GA
Practice Address - Zip Code:31042-2611
Practice Address - Country:US
Practice Address - Phone:478-864-3448
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA048854OtherPROVIDER MEDICAL LICENSE
GABJ6762997OtherPROVIDER DEA
GAH20724Medicare UPIN
GA08BBXKTMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
GABJ6762997OtherPROVIDER DEA